Study Suggests Medicaid Cost-Cutting Efforts Decrease Access to Needed Drugs
Originally published by Reuters Health, April 9, 2002
WASHINGTON (Reuters Health) — More than one in four Medicaid beneficiaries have been unable to obtain a prescribed drug due to cost, a new study has found, despite the fact that Medicaid covers drugs in all 50 states.
The study by the non-partisan Center for Studying Health System Change found that 26% of non-elderly adult Medicaid beneficiaries said they had forgone at least one prescription drug in the previous 12 months because of cost, a figure that was essentially the same as the percentage for uninsured adults.
The researchers said the most troubling aspect of the study, part of the center's biannual 60,000 person health-tracking survey, was that beneficiaries who had the hardest time affording their drugs tended to live in states with the most aggressive cost-cutting programs for Medicaid drug spending. State spending control efforts "appear to be decreasing access," said lead researcher Peter Cunningham at a news conference.
With Medicaid drug spending rising at rates up to 20% annually, many states have instituted a variety of mechanisms to try to curb that growth, Cunningham said. Those techniques include instituting drug copayments, limiting the number of prescriptions beneficiaries can fill each month, requiring use of generic drugs when available, and requiring physicians to get prior approval for certain prescriptions.
While no individual cost-containment technique appeared to impede access, Cunningham said, Medicaid patients in states that have instituted four or more such mechanisms were twice as likely to report inability to afford a prescription than those in states that had only one such policy or had instituted no cost-cutting measures, the study found.
Joan Henneberry of the National Governors' Association defended the need for states to curb drug spending, and said that some states—notably Maine and Michigan—have instituted programs that have saved money without apparent access problems.
But Leighton Ku of the Center on Budget and Policy Priorities, a liberal advocacy group, said that if the federal government offered assistance to states, "they [wouldn't] need to be doing things like limiting access to drugs." Ku, whose organization has called on Congress to temporarily increase federal Medicaid payments to states in response to the economic downturn, also said states and the federal government could work together to cut back the price of drugs rather than curb their use.
Alan Holmer, president of the Pharmaceutical Research and Manufacturers of America, issued a written statement in response to the study asserting that "Medicaid program directors who face tight budgets should thoroughly study their entire system rather than automatically cutting the pharmaceutical benefit."
He called measures such as restricting the number of prescriptions that a Medicaid recipient may fill each month "penny-wise, pound-foolish," noting that "prescription drugs are often the most cost-effective form of healthcare treatment, reducing hospitalizations, surgeries and nursing-home admissions."
